氯吡格雷治疗急性缺血性脑卒中的临床效果及对血浆大内皮素-1和血清脂蛋白-α的作用分析
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摘要
目的探讨对急性缺血性脑卒中患者选择氯吡格雷治疗后获得的临床效果以及对血浆大内皮素-1、血清脂蛋白-α产生的影响。方法选择我院2016年6月～2018年1月收治的120例急性缺血性脑卒中患者作为实验对象,采用抽签法分组后进行脑卒中治疗方式的研究。其中对照组(60例)选择常规疗法施治;观察组(60例)选择常规疗法+氯吡格雷施治。比较两组急性缺血性脑卒中患者ADL评分、NIHSS评分、VMCA、Lp-α以及big ET-1水平。结果观察组ADL评分、NIHSS评分、VMCA分别为(16.9±5.8)分、(11.2±3.3)分、(69.9±7.6)cm/s,对照组分别为(13.8±3.5)分、(14.9±3.2)分、(54.6±6.5)cm/s,同对照组对比,观察组ADL评分、NIHSS评分显著改善,VMCA显著升高(P<0.05);治疗前,两组患者的Lp-α水平无统计学意义(P>0.05),治疗后两组患者Lp-α水平均显著下降(P<0.05),且观察组明显优于对照组(P<0.05);治疗前,两组患者big ET-1水平无统计学意义(P>0.05),治疗后两组患者big ET-1水平均显著下降(P<0.05),且观察组明显优于对照组(P<0.05)。观察组和对照组各有1例谷丙转氨酶增高,但均未出现肝肾功能损害、脑出血等严重不良反应。结论采用氯吡格雷治疗急性缺血性脑卒中,患者ADL评分、NIHSS评分、VMCA、Lp-α以及big ET-1水平可以得到显著改善,病情好转。
Objective To investigate the clinical effects of clopidogrel in the patients with acute ischemic stroke and its effects on plasma macroendothelin-1 and serum lipoprotein-α. Methods 120 patients with acute ischemic stroke who were admitted to our hospital from June 2016 to January 2018 were selected as experimental subjects; the lottery method was applied for grouping and the treatment methods of stroke were investigated; the control group(60 cases): the conventional therapy was selected; the observation group(60 cases): the conventional therapy+clopidogrel drug treatment was selected; finally, the ADL score, NIHSS score, VMCA, Lp-α and big ET-1 levels were compared between the two groups of patients with acute ischemic stroke. Results The ADL score, NIHSS score, and VMCA in the observation group were(16.9±5.8) points,(11.2±3.3) points, and(69.9±7.6) cm/s, respectively. The control group was(13.8±3.5) points,(14.9±3.2) points,(54.6±6.5) cm/s, respectively. Compared with the control group, the ADL score and NIHSS score in the observation group were significantly improved, and VMCA was increased significantly(P<0.05); before treatment, there was no statistically significant difference in Lp-α levels between the two groups(P>0.05). After treatment, the Lp-α levels in the two groups were significantly decreased(P<0.05), and the observation group was significantly better than the control group(P<0.05); before treatment, the levels of big ET-1 in the two groups were not statistically significant(P>0.05).After treatment, the levels of big ET-1 in the two groups were significantly decreased(P<0.05), and the observation group was significantly better than the control group(P<0.05). There was a case showing increase in alanine aminotransferase in the observation group and the control group. However, there were no serious adverse reactions such as liver and kidney dysfunction and cerebral hemorrhage. Conclusion Medical staff use clopidogrel as medical treatment of acute ischemic stroke. The ADL score, NIHSS score, VMCA, Lp-α and big ET-1 levels can be significantly improved and the condition is improved in the patients.
Objective To investigate the clinical effects of clopidogrel in the patients with acute ischemic stroke and its effects on plasma macroendothelin-1 and serum lipoprotein-α. Methods 120 patients with acute ischemic stroke who were admitted to our hospital from June 2016 to January 2018 were selected as experimental subjects; the lottery method was applied for grouping and the treatment methods of stroke were investigated; the control group(60 cases): the conventional therapy was selected; the observation group(60 cases): the conventional therapy+clopidogrel drug treatment was selected; finally, the ADL score, NIHSS score, VMCA, Lp-α and big ET-1 levels were compared between the two groups of patients with acute ischemic stroke. Results The ADL score, NIHSS score, and VMCA in the observation group were(16.9±5.8) points,(11.2±3.3) points, and(69.9±7.6) cm/s, respectively. The control group was(13.8±3.5) points,(14.9±3.2) points,(54.6±6.5) cm/s, respectively. Compared with the control group, the ADL score and NIHSS score in the observation group were significantly improved, and VMCA was increased significantly(P<0.05); before treatment, there was no statistically significant difference in Lp-α levels between the two groups(P>0.05). After treatment, the Lp-α levels in the two groups were significantly decreased(P<0.05), and the observation group was significantly better than the control group(P<0.05); before treatment, the levels of big ET-1 in the two groups were not statistically significant(P>0.05).After treatment, the levels of big ET-1 in the two groups were significantly decreased(P<0.05), and the observation group was significantly better than the control group(P<0.05). There was a case showing increase in alanine aminotransferase in the observation group and the control group. However, there were no serious adverse reactions such as liver and kidney dysfunction and cerebral hemorrhage. Conclusion Medical staff use clopidogrel as medical treatment of acute ischemic stroke. The ADL score, NIHSS score, VMCA, Lp-α and big ET-1 levels can be significantly improved and the condition is improved in the patients.
引文
[1]中华医学会神经病学分会脑血管病学组,刘鸣,蒲传强.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,(4):246-257.
[2]高峰.急性缺血性脑卒中血管内治疗中国专家共识[J].中国脑血管病杂志,2014,11(10):556-560.
[3]中华医学会神经病学分会脑血管病学组,王拥军,刘鸣,等.中国缺血性脑卒中和短暂性脑缺血发作二级预防指南2014[J].中华神经科杂志,2015,(4):258-273.
[4]中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中国医学前沿杂志,2010,2(4):50-59.
[5]张玉明.奥拉西坦与吡拉西坦治疗脑卒中后认知功能障碍的疗效对比[J].中国实用神经疾病杂志,2015,18(14):28-30.
[6]Attal M,Lauwers-Cances V,Hulin C,et al.Lenalidomide,bortezomib,and dexamethasone with transplantation for myeloma[J].New England Journal of Medicine,2017,376(14):1311-1320.
[7]Yang Y,Salayandia VM,Thompson JF,et al.Attenuation of acute stroke injury in rat brain by minocycline promotes blood-brain barrier remodeling and alternative microglia/macrophage activation during recovery[J].Journal of Neuroinflammation,2015,12(1):26.
[8]Paquet M,Cerasuolo JO,Thorburn V,et al.Pathophysiology and risk of atrial fibrillation detected after ischemic stroke(PARADISE):a translational,integrated,and transdisciplinary approach[J].Journal of Stroke and Cerebrovascular Diseases,2018,27(3):606-619.
[9]左凤同,董爱勤.双重抗血小板聚集治疗缺血性脑卒中[J].脑与神经疾病杂志,2016,24(1):55-59.
[10]吉维忠,吴世政,胡全忠,等.不同抗血小板聚集治疗方案对高原缺血性卒中治疗对比研究[J].中国卒中杂志,2016,11(5):344-348.
[11]刘丹,马强,谷新医,等.急性缺血性脑卒中伴脑微出血老年患者糖化血红蛋白和血脂水平及NIHSS评分[J]实用预防医学,2018,25(4):477-479.
[12]周国强,黄宗青,张志,等.增强型体外反搏对缺血性脑卒中患者超敏C反应蛋白和内皮素1的影响[J].中国神经精神疾病杂志,2016,42(3):129-133.
[13]刘向远,周先举,高萍,等.腔隙性脑卒中患者的细胞间粘附分子-1和内皮素-1的血浆水平及其临床意义[J]中华全科医学,2015,13(12):1912-1914.
[14]陈宗羡,田跃雷,李冬梅.青年脑卒中患者血清脂蛋白(α)与氧化低密度脂蛋白含量相关性分析[J].河北北方医学院报(医学版),2006,23(5):24-25.
[15]张玉惠,刘俊,陈金国,等.替格瑞洛与氯吡格雷对急性冠状动脉综合征患者血小板聚集的对比分析[J].蚌埠医学院学报,2016,41(6):733-735,738.
[16]张丽,马婧怡,花晓薇.氯吡格雷治疗缺血性脑卒中后病情进展与CYP2C19基因多态性的研究观察[J].临床合理用药杂志,2017,10(17):29-30.
[17]Nakamura M,Ishibashi Y,Tanaka F,et al.Ability of B-Type Natriuretic Peptide Testing to Predict Cardioembolic Stroke in the General Population―Comparisons With C-Reactive Protein and Urinary Albumin[J].Circulation Journal,2018,82(4):1017-1025.
[18]Hutanu A,Maier S,B觍lasa R,et al.Plasma phosphorylated neurofilament heavy chains as a potential marker for ischemic stroke patients[J].Revista Romana de Medicina de Laborator,2018,26(1):59-64.
[19]Imano H,Iso H,Kitamura A,et al.Nonfasting Glucose and Incident Stroke and Its Types―The Circulatory Risk in Communities Study(CIRCS)[J].Circulation Journal,2018,82(6):1598-1604.
[20]蒋慧.氯吡格雷对急性缺血性脑卒中患者疗效及血清炎性标记物的影响效果分析[J].贵州医药,2016,(8):828-830.
[2]高峰.急性缺血性脑卒中血管内治疗中国专家共识[J].中国脑血管病杂志,2014,11(10):556-560.
[3]中华医学会神经病学分会脑血管病学组,王拥军,刘鸣,等.中国缺血性脑卒中和短暂性脑缺血发作二级预防指南2014[J].中华神经科杂志,2015,(4):258-273.
[4]中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中国医学前沿杂志,2010,2(4):50-59.
[5]张玉明.奥拉西坦与吡拉西坦治疗脑卒中后认知功能障碍的疗效对比[J].中国实用神经疾病杂志,2015,18(14):28-30.
[6]Attal M,Lauwers-Cances V,Hulin C,et al.Lenalidomide,bortezomib,and dexamethasone with transplantation for myeloma[J].New England Journal of Medicine,2017,376(14):1311-1320.
[7]Yang Y,Salayandia VM,Thompson JF,et al.Attenuation of acute stroke injury in rat brain by minocycline promotes blood-brain barrier remodeling and alternative microglia/macrophage activation during recovery[J].Journal of Neuroinflammation,2015,12(1):26.
[8]Paquet M,Cerasuolo JO,Thorburn V,et al.Pathophysiology and risk of atrial fibrillation detected after ischemic stroke(PARADISE):a translational,integrated,and transdisciplinary approach[J].Journal of Stroke and Cerebrovascular Diseases,2018,27(3):606-619.
[9]左凤同,董爱勤.双重抗血小板聚集治疗缺血性脑卒中[J].脑与神经疾病杂志,2016,24(1):55-59.
[10]吉维忠,吴世政,胡全忠,等.不同抗血小板聚集治疗方案对高原缺血性卒中治疗对比研究[J].中国卒中杂志,2016,11(5):344-348.
[11]刘丹,马强,谷新医,等.急性缺血性脑卒中伴脑微出血老年患者糖化血红蛋白和血脂水平及NIHSS评分[J]实用预防医学,2018,25(4):477-479.
[12]周国强,黄宗青,张志,等.增强型体外反搏对缺血性脑卒中患者超敏C反应蛋白和内皮素1的影响[J].中国神经精神疾病杂志,2016,42(3):129-133.
[13]刘向远,周先举,高萍,等.腔隙性脑卒中患者的细胞间粘附分子-1和内皮素-1的血浆水平及其临床意义[J]中华全科医学,2015,13(12):1912-1914.
[14]陈宗羡,田跃雷,李冬梅.青年脑卒中患者血清脂蛋白(α)与氧化低密度脂蛋白含量相关性分析[J].河北北方医学院报(医学版),2006,23(5):24-25.
[15]张玉惠,刘俊,陈金国,等.替格瑞洛与氯吡格雷对急性冠状动脉综合征患者血小板聚集的对比分析[J].蚌埠医学院学报,2016,41(6):733-735,738.
[16]张丽,马婧怡,花晓薇.氯吡格雷治疗缺血性脑卒中后病情进展与CYP2C19基因多态性的研究观察[J].临床合理用药杂志,2017,10(17):29-30.
[17]Nakamura M,Ishibashi Y,Tanaka F,et al.Ability of B-Type Natriuretic Peptide Testing to Predict Cardioembolic Stroke in the General Population―Comparisons With C-Reactive Protein and Urinary Albumin[J].Circulation Journal,2018,82(4):1017-1025.
[18]Hutanu A,Maier S,B觍lasa R,et al.Plasma phosphorylated neurofilament heavy chains as a potential marker for ischemic stroke patients[J].Revista Romana de Medicina de Laborator,2018,26(1):59-64.
[19]Imano H,Iso H,Kitamura A,et al.Nonfasting Glucose and Incident Stroke and Its Types―The Circulatory Risk in Communities Study(CIRCS)[J].Circulation Journal,2018,82(6):1598-1604.
[20]蒋慧.氯吡格雷对急性缺血性脑卒中患者疗效及血清炎性标记物的影响效果分析[J].贵州医药,2016,(8):828-830.